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Winners and losers in health care reform WSJ explores implications

The overhaul's extension of insurance to millions of more Americans likely will add to the patient loads of many doctors, which could exacerbate the physician shortage and raises questions about whether having insurance will really mean gaining access to health care.

The U.S. already faces a shortage of more than 100,000 physicians in the next 15 years, and only 27,000 new doctors are trained each year. The demands placed on physicians by the new legislation may lead to greater use of other health-care professionals, such as nurse practitioners and physician assistants.

The legislation doesn't address another big objective for doctorsâ€”eliminating a pending 21% cut in Medicare reimbursement rates. The cut has been repeatedly delayed by Congress, but physicians were pushing to have it eliminated. Lawmakers have balked at doing so because it would add billions to the official deficit figure.

To persuade more doctors to take Medicaid patients, the bill increases reimbursement rates for Medicaid”the state and federal program that covers health care for the poor”for some services to be equal to that of Medicare. But it also could create an influx of patients for doctors that will accept new patients and participate in the Medicaid program.

"I think they'll get bombed," said Jim Greenwood, chief executive of Concentra, an employer-based provider of medical care that employs over 1,000 clinicians, said of physicians who accept Medicaid.

Concentra doesn't accept Medicaid in its clinics because of the low reimbursement rates and will continue this practice even with the improved Medicaid rates, said Mr. Greenwood.

The higher Medicaid reimbursements also apply only to primary-care physicians and not to specialists. "It's a tilt toward primary care and away from specialists," said Phil Miller, a spokesman for Merritt Hawkins, the largest physician search firm in the U.S.

"There's no question that something has to be done to make primary care more attractive. Unfortunately, I don't know if robbing Peter to pay Paul makes sense."